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Searching for Evidence Supporting P4P

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In the past several years, employers, purchasers, and health plans have announced new programs to reward health care quality—ranging from physician bonuses for meeting childhood immunization targets to additional reimbursements to hospitals that invest in information technology. To study these efforts, the authors undertook a systematic examination of the evidence supporting quality-based pay-for-performance, looking at both health care literature and studies of payment incentives in other settings. In this literature review, the researchers found only seven published, peer-reviewed, empirical studies on the paying for quality in health care, one of which had indeterminate results. Among the studies of similar types of incentives in non-health care settings, the researchers found a "scarcity" of evidence in support of paying for quality. Overall, the authors report mixed results, as well as related evidence suggesting unintended consequences—like the avoidance of high-risk patients. Future success will depend upon the careful design and implementation of pay-for-performance programs.